MEDICARE: DR. AMAL K MUKHERJEE M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician		IL

General Provider Information

NPI Number	:	1700941176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMAL K MUKHERJEE M.D

Provider Business Mailing Address
First Line	:	1409 BURR OAK RD APT 102A
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-2997
Country	:	US
Telephone Number	:	773-583-5558
Fax Number	:	773-583-0221

Provider Business Practice Location Address
First Line	:	4101 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2813
Country	:	US
Telephone Number	:	773-583-5558
Fax Number	:	773-583-0221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	07/08/2007

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